An Adaptive Antiretroviral Therapy Adherence Intervention for Youth with HIV Through Text Message and Cell Phone...

Area of Science:

• Public Health
• Infectious Diseases
• Adolescent Medicine

Background:

• Youth living with HIV (Human Immunodeficiency Virus) exhibit suboptimal antiretroviral medication adherence.
• Poor adherence in youth is linked to increased viral load (VL) and disease progression.
• Innovative, technology-based interventions are needed to improve adherence rates in this demographic.

Purpose of the Study:

• To evaluate the efficacy of cell phone support (CPS) calls versus personalized text message (SMS) reminders for improving medication adherence in youth with HIV.
• To assess the impact of intervention tapering and incentives on sustained adherence.
• To compare the effectiveness of CPS and SMS interventions in improving viral load suppression and self-reported adherence.

Main Methods:

• A randomized controlled trial involving 83 youth (ages 15-24) with adherence ≤80% or VL ≥200.
• Participants were randomized to brief weekday CPS calls or daily two-way SMS reminders for 3 months.
• Subsequent randomization to interventions (SMS, CPS, usual care) or tapered interventions with potential incentives over 12 months; adherence and VL monitored.

Main Results:

• Both CPS and SMS interventions significantly improved adherence over 12 months (P < .001).
• CPS interventions demonstrated significantly greater improvements in 7-day self-reported adherence compared to SMS (P < .027).
• Tapered interventions led to improved adherence compared to standard care (P < .001).

Conclusions:

• Both SMS and CPS are effective interventions for improving antiretroviral adherence in youth with HIV.
• Cell phone support calls may be more effective than SMS reminders for enhancing adherence.
• Tapering interventions is beneficial for maintaining adherence post-initial treatment; further research on sequencing and incentives is warranted.